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Question: I was involved in a car crash. I have medical insurance. Am I responsible to pay these bills back when I settle my case?

Answer: This is based on two recent cases I have had! I wish it wasn't, but two clients hired me on cases because the other party's insurance company told them lies about their bills. In the first case, my client was told he would not have to reimburse Rawlings, who was collecting on behalf of Blue Shield. In the second case, my client was told that she would be personally liable to Kaiser if she did not settle the case. The one thing these two cases have in common: both people were lied to by adjusters. (I don't like using that word, but it is the only word that fits!)

Let's start with the easy scenario. There are a ton of different scenarios I can give you. But, to keep things simple, I am going to give you the three most common: you have no health insurance, you are insured by a health plan that is not Kaiser and you are insured by Kaiser.

You are involved a motor vehicle collision and you do not have insurance. You incur bills for your treatment. You are personally liable for these bills and MUST pay them back. You MAY be able to negotiate them, but your creditors are coming after you - one way or another. So if you settle your case, you pay them back. If you don't settle your case, they sue you. If you do not pay them back, they will sue you for the money. Easy, right?

Now, we can make it harder. You have insurance with Blue Shield or Blue Cross or Anthem or Aetna or CIGNA or.......... well, you get the idea. They pay your hospital bill and doctor's bills. You go to settle your case. You get paid. Generally, they are entitled to any money you recover from a third party (3rd party). A third party is the other person - or the other person's insurance company. So when you settle your case, you have to pay them back. Now, sometimes you can pay them back less then they paid you. But, if it is an ERISA plan, in other words, paid for by your employer, you generally have to pay them back in full.

What about if you have Kaiser? I know, Kaiser doesn't bill you. Right. But, wrong too. When you are injured as a result of someone else's negligence, such as a slip and fall or car accident, Kaiser hires a company called Equian (it used to be called Trover and before that, Healthcare Recoveries). Equian obtains your records and prepares a bill. They send that bill to you or to your attorney. You then have to pay them back. But, unlike the ERISA plans discussed above, Kaiser will typically reduce the amount you have to pay back. So, that is the good news.

The moral of the story: do NOT trust the adjuster. Nope. Never. Do not do it. The adjuster is going to tell you whatever they need to tell you so you will settle your case. Do not listen to them. If you are unsure about whether you have to pay back your medical insurance or your medical providers, then talk to an attorney. Get some actual advice from someone you trust and someone who is on your side!

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This blog is made available by the lawyer publisher for educational purposes only as well as to give information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog publisher. The Blog should not be used as a substitute for competent legal advice from a licensed professional attorney in your state. Jonathan G. Stein, is licensed to practice law in the state of California only.
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